PN 408 FINAL EXAM – LEWIS MED-SURG NURSING
Actual Exam | Official Exam – Complete Q&A with
Rationales – Pass Guaranteed - A+ Graded
TABLE OF CONTENTS
Section 1 | Chapter 54 — Neurologic Disorders | Q1 – Q10
Section 2 | Chapter 56 — Cerebrovascular Disorders | Q11 – Q20
Section 3 | Chapter 59 — Musculoskeletal Disorders | Q21 – Q30
Section 4 | Chapter 61 — Arthritis and Connective Tissue Disorders | Q31 – Q40
Section 5 | Chapter 63 — Critical Care and Complex Conditions | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
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SECTION 1: CHAPTER 54 — NEUROLOGIC DISORDERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
19-year-old college student Marcus is admitted after his first witnessed generalized
tonic-clonic seizure. The nurse is preparing his room before he returns from imaging.
A. Place a padded tongue blade at the bedside for immediate use
B. Pad the side rails and ensure suction equipment is at the bedside ✓ CORRECT
C. Apply soft wrist restraints to prevent injury during the seizure
D. Dim the lights completely and restrict all visitors to prevent overstimulation
Correct Answer: B
Rationale: Padding side rails and ensuring suction is available are priority safety
measures for a patient at risk for seizure. Tongue blades are no longer recommended
because they can break teeth or cause airway obstruction. In practice, seizure pads and
suction should be checked at the start of every shift.
Question 2 of 50
,24-year-old graphic designer Leah is brought to the ED with fever, severe headache, and
nuchal rigidity. The physician asks the nurse to assess for meningeal irritation.
A. Ask the patient to touch the chin to the chest while lying supine
B. Passively flex the patient's hip and knee while the patient is prone
C. Stroke the lateral sole of the foot and observe for toe movement
D. Flex the patient's neck and observe for involuntary flexion of the hips and knees ✓
CORRECT
Correct Answer: D
Rationale: Brudzinski sign is positive when passive neck flexion causes involuntary
flexion of the hips and knees, indicating meningeal irritation. Asking the patient to
actively touch the chin to the chest tests for nuchal rigidity but does not elicit
Brudzinski. The plantar reflex test is for neurologic upper motor neuron lesions, not
meningeal irritation.
Question 3 of 50
45-year-old construction foreman Joe had a craniotomy for tumor removal this morning.
His ICP monitor reads 18 mmHg, and the nurse is preparing to reposition him in bed.
A. Elevate the head of the bed to 30 degrees and keep the neck in neutral alignment ✓
CORRECT
B. Place the patient in Trendelenburg position to improve cerebral perfusion
C. Turn the patient's head to the right side to promote venous drainage
D. Keep the patient flat with a small pillow under the knees for comfort
Correct Answer: A
Rationale: Elevating the head 30 degrees with neutral neck alignment promotes venous
drainage and reduces ICP. Trendelenburg position increases cerebral blood volume and
can worsen ICP. Turning the head sharply or placing pillows under the knees can impede
jugular venous return and raise intracranial pressure.
Question 4 of 50
, 62-year-old retired teacher Eleanor arrives in the ED after an MVA. She opens her eyes to
painful stimulus, withdraws from pain, and makes incomprehensible sounds. The nurse
calculates her Glasgow Coma Scale score.
A. A score of 6
B. A score of 10
C. A score of 8 ✓ CORRECT
D. A score of 12
Correct Answer: C
Rationale: The GCS is 8 because the patient scores 2 for eye opening to pain, 2 for
incomprehensible verbal sounds, and 4 for withdrawal from pain. A score of 10 would
require localizing to pain or better verbal response. A GCS of 8 or below typically
indicates the need for airway protection and close neuro monitoring.
Question 5 of 50
58-year-old accountant Robert has myasthenia gravis and takes pyridostigmine at
home. This morning he reports increased weakness, excessive salivation, diarrhea, and
sweating.
A. Administer the next dose of pyridostigmine immediately
B. Hold the anticholinesterase medication and notify the provider ✓ CORRECT
C. Prepare for immediate endotracheal intubation and mechanical ventilation
D. Increase the frequency of suctioning and administer atropine
Correct Answer: B
Rationale: Excessive salivation, diarrhea, and sweating along with weakness indicate a
cholinergic crisis from anticholinesterase overdose, so the medication should be held.
Administering more pyridostigmine would worsen the crisis. While respiratory support
must be available, immediate intubation is not automatically indicated unless the
patient cannot maintain adequate ventilation.
Actual Exam | Official Exam – Complete Q&A with
Rationales – Pass Guaranteed - A+ Graded
TABLE OF CONTENTS
Section 1 | Chapter 54 — Neurologic Disorders | Q1 – Q10
Section 2 | Chapter 56 — Cerebrovascular Disorders | Q11 – Q20
Section 3 | Chapter 59 — Musculoskeletal Disorders | Q21 – Q30
Section 4 | Chapter 61 — Arthritis and Connective Tissue Disorders | Q31 – Q40
Section 5 | Chapter 63 — Critical Care and Complex Conditions | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CHAPTER 54 — NEUROLOGIC DISORDERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
19-year-old college student Marcus is admitted after his first witnessed generalized
tonic-clonic seizure. The nurse is preparing his room before he returns from imaging.
A. Place a padded tongue blade at the bedside for immediate use
B. Pad the side rails and ensure suction equipment is at the bedside ✓ CORRECT
C. Apply soft wrist restraints to prevent injury during the seizure
D. Dim the lights completely and restrict all visitors to prevent overstimulation
Correct Answer: B
Rationale: Padding side rails and ensuring suction is available are priority safety
measures for a patient at risk for seizure. Tongue blades are no longer recommended
because they can break teeth or cause airway obstruction. In practice, seizure pads and
suction should be checked at the start of every shift.
Question 2 of 50
,24-year-old graphic designer Leah is brought to the ED with fever, severe headache, and
nuchal rigidity. The physician asks the nurse to assess for meningeal irritation.
A. Ask the patient to touch the chin to the chest while lying supine
B. Passively flex the patient's hip and knee while the patient is prone
C. Stroke the lateral sole of the foot and observe for toe movement
D. Flex the patient's neck and observe for involuntary flexion of the hips and knees ✓
CORRECT
Correct Answer: D
Rationale: Brudzinski sign is positive when passive neck flexion causes involuntary
flexion of the hips and knees, indicating meningeal irritation. Asking the patient to
actively touch the chin to the chest tests for nuchal rigidity but does not elicit
Brudzinski. The plantar reflex test is for neurologic upper motor neuron lesions, not
meningeal irritation.
Question 3 of 50
45-year-old construction foreman Joe had a craniotomy for tumor removal this morning.
His ICP monitor reads 18 mmHg, and the nurse is preparing to reposition him in bed.
A. Elevate the head of the bed to 30 degrees and keep the neck in neutral alignment ✓
CORRECT
B. Place the patient in Trendelenburg position to improve cerebral perfusion
C. Turn the patient's head to the right side to promote venous drainage
D. Keep the patient flat with a small pillow under the knees for comfort
Correct Answer: A
Rationale: Elevating the head 30 degrees with neutral neck alignment promotes venous
drainage and reduces ICP. Trendelenburg position increases cerebral blood volume and
can worsen ICP. Turning the head sharply or placing pillows under the knees can impede
jugular venous return and raise intracranial pressure.
Question 4 of 50
, 62-year-old retired teacher Eleanor arrives in the ED after an MVA. She opens her eyes to
painful stimulus, withdraws from pain, and makes incomprehensible sounds. The nurse
calculates her Glasgow Coma Scale score.
A. A score of 6
B. A score of 10
C. A score of 8 ✓ CORRECT
D. A score of 12
Correct Answer: C
Rationale: The GCS is 8 because the patient scores 2 for eye opening to pain, 2 for
incomprehensible verbal sounds, and 4 for withdrawal from pain. A score of 10 would
require localizing to pain or better verbal response. A GCS of 8 or below typically
indicates the need for airway protection and close neuro monitoring.
Question 5 of 50
58-year-old accountant Robert has myasthenia gravis and takes pyridostigmine at
home. This morning he reports increased weakness, excessive salivation, diarrhea, and
sweating.
A. Administer the next dose of pyridostigmine immediately
B. Hold the anticholinesterase medication and notify the provider ✓ CORRECT
C. Prepare for immediate endotracheal intubation and mechanical ventilation
D. Increase the frequency of suctioning and administer atropine
Correct Answer: B
Rationale: Excessive salivation, diarrhea, and sweating along with weakness indicate a
cholinergic crisis from anticholinesterase overdose, so the medication should be held.
Administering more pyridostigmine would worsen the crisis. While respiratory support
must be available, immediate intubation is not automatically indicated unless the
patient cannot maintain adequate ventilation.
